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Battling Foot Drop With Functional Electrical Stimulation

A while back, I wrote about a pretty common issue that plagues many people who suffer from multiple sclerosis: foot drop. In my overview of the issue, I touched on a few of the ways to improve it. One of those methods is referred to as Functional Electrical Stimulation (FES). Well, I recently had a friend begin to use an FES unit to combat her foot drop, so I thought I’d do a deeper dive on it, as well as get her thoughts, now that she’s been using it for a few weeks.

What is foot drop?

First, a little reminder about foot drop. A fairly common symptom of MS, foot drop occurs during the process of walking because one of the nerves that our brain uses to communicate with muscles in our foot has been damaged by the demyelination of MS. These signals that our brain is subconsciously sending to our legs and feet to make the act of walking happen either don’t get there at all or are delayed because of the damaged nerves. Our brain says “lift your foot” but it fails to lift. Many times, all of the other commands our brain sent out to make us walk managed to get there successfully though. So with everything in motion, except that one foot, we often end up dragging our one foot or even falling because everything else is in motion. You can see how this can be a real, even dangerous, problem.

Functional Electrical Stimulation

One method used to combat foot drop is the use of a Functional Electrical Stimulation (FES) device. Consisting of a control box, electrodes, and a battery, it is typically worn on the problem leg, below the knee. The device sends low-level electrical signals to the nerve that tells the leg muscles to move the foot. It is essentially taking over for the damaged nerve and forcing a signal to those muscles that are required. When calibrated correctly, the control box of the device will know when you are lifting your leg to move and when your foot is back on the ground. This calibration is important and can take some time to get right. While FES devices are currently being used for foot drop, there are ongoing studies to see if it can be used in other areas, such as swallowing.

User experience

While I do suffer from foot drop, unlike most things I discuss here, I have no firsthand knowledge of using an FES device. So, I spoke to someone who does, my friend Ann, who recently began using an FES device, a Bioness L300 Go model. Below are my questions and her answers.

Seeking out the FES device

What led you to seek out a functional electrical stimulation device?

Ann: I currently experience intermittent hyperextension of the left knee, which seemed to be caused by weakened quad muscles and/or hamstrings. I had seen an advertisement in 2016 and while I didn’t have these issues back then, I decided to follow the lead and try it out, knowing the progression of my MS could make this device important in the future. Back then, it involved a sensor placed in sneakers (the type of compatible footwear was limited).

Bioness L300 Go

Ann: Now, I’m the elated owner of the Bioness L300 Go model, thigh cuff, and calf component. As predicted three years ago, my walking did get increasingly affected, particularly when fatigued by distance. Today’s model is Bluetooth controlled, and it predicts and adapts to your gait needs. No more sensors and wires! It is now multi-directional and even has a bicycle setting. For my job, I am on my feet and this device enables me to get through those last hours of my shift and saves me a lot of energy that would otherwise be exerted trying to compensate. I also don’t have to use a cane, so I have both hands free to do my job in retail cosmetics.

Functional Electrical Stimulation device strapped around a person's leg along with a thigh cuff and calf component

Improvements using the FES

Have you noticed an improvement in your issues since using it?

Ann: When you first receive the device, there is a training protocol that you follow for the first couple of weeks to get your muscles used to being assisted, without overtaxing them. I felt like, very shortly after starting, different muscles were starting to pick up the messages, and my general gait improved. My compensatory pain in my right hip had also lessened significantly.

Negatives to using the FES

Have there been any negatives? 

Ann: The blaring negative is the cost to a patient, and the reluctance or refusal of insurance companies to help. They often consider multiple sclerosis “unrehabilitatable” and would rather limit coverage to conditions like strokes. For me, it was more an issue of continued functionality in my daily life and work (and perhaps avoiding a hip replacement down the line.) I received some assistance from the MS Foundation and started saving early, predicting its usefulness. Another negative could be that it is a bit complicated involving the saturation of electrodes to properly ensure electricity is conducted properly. The company representatives at Bioness are good about providing calibration/demonstrations for the device, but that only goes so far.

Physical therapy

Ann: I would say any patient that has been properly fitted by Bioness should have follow-up physical therapy as directed by their physician to get maximum benefit.

Recommendations

Do you recommend an FES device?

Ann: I do, for very specific people, like most with this disease, it’s highly individual.

Conclusion

A huge thanks to my friend Ann for answering my questions; this is one of those things I’ve heard about and understand, but have never gotten to experience firsthand. It sounds like the device has been incredibly helpful for her (which is what really made me want to write this). Unfortunately, it sounds like it can be a bit expensive and a bit of a hassle, particularly if you are dealing with the healthcare landscape in the United States. There are still other ways to battle foot drop though, like braces, physical therapy, and even surgery. For some though, those methods won’t work, and an FES device will be the best option.

There are different options to combat foot drop

Whether foot drop is an issue for you or not, I think an important takeaway is that there are always options out there. I think it’s also pretty great to see that while we keep getting new medications and making progress on that front, there are other areas, in science and technology, being explored to help those with multiple sclerosis.

Thanks so much for reading and always feel free to share!

Devin

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Azjackie
    4 days ago

    Thank you for sharing your friend’s experience. I will be using the Bioness L300 Go very soon. I appreciate her unbiased information.
    I started my journey with Bioness in 2017. At that time I did not qualify due to a titanium plate and screws in my leg from a drunk driver crashing into me before MS. Not qualifying made for a dark year then to add to my depression another jerk crashed into me in the Fall. That made me feel my darkness was a target.
    2018 with Bioness was better. They updated their device and wanted to test. Due to my location that wasn’t possible.
    November 2019 was the shining light. A Bioness clinical specialist in my town to test. In the very building I was diagnosed.
    I tested. I have foot drop and a tendency to swing my leg to clear my foot use a rollator. The swinging has caused terrible mid back pain. For me the Bioness is incredible. I can walk again.
    It was sad he had to take his testing equipment and leave but it made me fight harder to get one.
    Like many I had to find a benefactor. I completed applications and wrote letters. Then a miracle, by a fluke my Brother was fixing my garage door opener and transmitter. He is a structural engineer (technical nerd). He saw my magazine advertisement asking about it. I gave a brief explanation he went away but researched Bioness. A week later offered to buy it for me saying he wants to see me walk. I hesitated, what if it doesn’t work for me?
    I gave in. He bought the device for me. I have it and the clinical specialist will be here to callibrate and I get to celebrate life again. Diagnosed January 30, 2008. My 50th birthday will be great.

  • corgi9
    4 days ago

    Hey Devin
    Have been dealing with foot drop off and on for a very long time. Been through various styles of braces without much luck over the years. Looked into the FES but decided against it because of the cost and reviews I read where it didn’t work out. But like you noted, we are all different and have different experience with the treatments we choose.
    PS: If you know anybody who needs a right foot shoe/sneaker let me know because I have plenty of them. It seems that every few months my left shoe/sneaker goes in the trash….swears out, holes at the top from dragging my leg !!!

  • Recanize
    1 week ago

    Hey Devin,
    My 2 cents… I have and used the L300. It was difficult to get the funding through my support group but it did rid me of my brace, cane, and wheelchair. I used the FES religiously for about a year both in and out of physical therapy where I learned how to exercise, teach and strengthen those muscles. I have not used it or any aide for about 2 years now. Yeah, my drop foot is still not perfect and I need to exercise those muscles daily as part of a stretching:strengthening:calisthenics: meditation routine. Some days are better than others but hey…

  • Azjackie
    4 days ago

    Thank You for your information. I am excited to hear your experience. I was curious if “communication pathways” could be trained. You’ve proved the possibility! Awesome!!!

  • Devin Garlit moderator author
    1 week ago

    Thank you @Recanize, appreciate the comment, I’ve met so few people who’ve actually been able to get one of these.

  • Meglette63
    1 week ago

    Foot drop. I trip a lot. My left leg drags and my toe catches on what ever is there…and down I go. I have scrapes and scars on my knees and shins; battle wounds from just trying to live and move.
    My orthopedic podiatrist watched me walk, and diagnosed my with foot drop and that I should be wearing bilateral AFO foot braces (I think that’s what the were called). I spent a lot of time and money getting these braces only to find that they sucked…and I don’t wear them. They are on the floor in a corner of a closet.
    It wasn’t foot drop at all. It was the messed up neural communication to my hip and knee muscles that was causing the left foot to drag.
    Many PT sessions later I am able to walk without the foot drag (and the awful braces). It just takes me a ton of thinking about the step. I think that I have developed new neural pathways for walking. That thinking part of walking, however, takes energy…a mess of energy. And so, after my walk, I’m pretty wiped out. Maybe my story speaks to some of y’all. I welcome any comments.
    Thanks for reading and blessings on your day

  • Azjackie
    4 days ago

    I am familiar with those battle scars. I spend a lot of time on the floor and ground. I figure it’s better to crawl there than fall. You are so right with exhaustion in mobility.

  • Devin Garlit moderator author
    1 week ago

    Thank you @Meglette63, PT is so helpful to many people and should definitely be the first line of defense for issues like this. Sadly, to few neuros are quick enough to recommend it.

  • Kim Dolce moderator
    1 week ago

    Devin and Ann, thank you for discussing this kind of mobility aid. Years ago I looked into the Walkaide, an FES similar to Bioness. But it cost $5,000 and insurance didn’t cover it. So I walk very carefully and haven’t tripped and fallen for many years. I also notice that my foot drop gets worse if I slept less than 7 hours the night before.

    Although most of us are too poor to finance these devices, it’s good to know what technology is out there and what organizations might help with the cost.

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